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July 12, 2010

Universal Cholesterol Screenings For Children

by Sam Savage

Thousands of children with high levels of LDL cholesterol are going untreated, as current guidelines exclude as many as 10-percent of those who could benefit from medication, according to a new study completed by researchers at the West Virginia University (WVU) in Morgantown.

According to a July 12 Time Magazine article, "Current government recommendations suggest screening for high cholesterol in children with a family history of heart disease or high cholesterol (with at least one parent or grandparent who has suffered a premature heart event such as heart attack or stroke, or at least one parent with total cholesterol levels above 240 mg/dL). The guidelines also recommend that youngsters whose parents are not aware of their family history of heart disease be screened."

However, new research is questioning whether those guidelines, which were issued by the government's National Cholesterol Education Program (NCEP), are effective enough.

In a study published in the latest issue of the journal Pediatrics, Dr. William Neal and his WVU colleagues are calling for all children to be tested. The WVU scientists studied a group of more than 20,000 fifth grade students in the state of West Virginia.

According to Frederik Joelving of Reuters health, "Neal and colleagues found that more than one percent of all fifth-graders had cholesterol levels that warranted drug treatment. But a third of those children didn't have relatives with heart disease or high cholesterol, and so wouldn't have been screened under the current guidelines."

As Time reporter Alice Park notes, "because West Virginia has one of the nation's highest rates of death from heart disease, the state has since 2000 offered free and universal cholesterol screening in all fifth graders enrolled in public schools. That allowed Neal and his team to determine how many children who actually had high cholesterol would have been missed if they had been screened based on federal guidelines."

"Among the 5,798 children who would not have been screened, nearly 10% had elevated LDL cholesterol levels (above 130 mg/dL), according to the new study published in the August issue of Pediatrics. And 1.7% had levels high enough (above 160 mg/dL) to warrant cholesterol-lowering medications. Indeed, of all children in the study whose LDL was above 160, one-third were in the group who would not have been screened," she added.

Based on the study's results, Neal told Reuters, "I have gradually become convinced that universal screening in children is not only preferable, but necessary."

Universal screenings would be costly, however, and not all experts agree they are necessary or beneficial. For example, Dr. Michael L. LeFevre of the U.S. Preventive Services Task Force does not recommend routine cholesterol screening in children of any age. As LeFevre told Joelving, "there is no evidence that starting a ten-year-old on cholesterol-lowering drugs will prevent heart disease 40 years later," and statin treatment for youngsters had not yet been proven safe.

The NCEP was originally launched by the National Heart, Lung, and Blood Institute (NHLBI) in November 1985. According to the NCEP website, "The goal of the NCEP is to contribute to reducing illness and death from coronary heart disease (CHD) in the United States by reducing the percent of Americans with high blood cholesterol. Through educational efforts directed at health professionals and the public, the NCEP aims to raise awareness and understanding about high blood cholesterol as a risk factor for CHD and the benefits of lowering cholesterol levels as a means of preventing CHD."

American Heart Association (AHA) president Dr. Ralph Sacco told Park, "Maybe the way we are doing family screening, with a very simplistic questionnaire about any parent having early heart disease, or having high blood cholesterol, is not effective"¦ I think we need more effective screening tools. We need to assess these options before jumping to possible universal screening."

Sacco also told Time magazine that the AHA and the American Academy of Pediatrics (AAP) looked at several different factors when recommending cholesterol screenings in younger children, including "The weight of the child, his waist circumference and whether maybe he has siblings who are overweight would help to select a group that is at greater risk of having high cholesterol"¦ Now that we have this data, it does call into question these original guidelines from the government."

The next NCEP update is expected to come sometime next spring, according to Park.